Lantus
Lantus is the brand name for insulin glargine, an insulin analog made by AventisLantus-Insulin Glargine Remedyfind.com. Lantus is a very long-acting insulin (lasting up to 24 hours in humans) that uses pH reactions to form micro-precipitates under the skin, which create a time-release action. Absorption studies in humansEMEA Scientific Discussion:Lantusindicate that 24 hours after being injected, approximately 50% of the Lantus dose remained at the injection site; after 48 hours, the amount was about 20%. Use in Cats Because of cats' faster metabolism, long-acting insulins like Lantus (and perhaps Levemir) are gaining a good reputation in veterinary research for regulating cats for a full 12 hours at a time, often better than some of their shorter-acting cousins. Proponents of Lantus in feline use point out that it lasts a full 12 hours in many cats, has a very gentle onset, a negligible peak, and (some claim) less chance of triggering hypo or rebound than faster-acting insulins. The famous Queensland University studiesQueensland University Studies showed that a simple protocol (in a 24-hour monitored, veterinary environment) could bring many cats into remission in a few weeks. Detractors say that Lantus lasts too long and causes too much overlap in some cats, whereas other cats don't achieve more than 9 hours' duration on a shot. Its action is very dependent on the individual cat's body. People have also noted that with Lantus it is difficult to time the next shot because its action often stops abruptly. Lantus is expensive, especially with its very fast expiry (28 days) and poor availability in smaller vial sizes than 10mL. The use of Lantus is still quite new in cats, and the collective wisdom on the best ways to do so is not yet congealed. One particular user's documented protocol Tilly's Lantus/Levemir protocol has been seen to work well and lead to remission on a few cats using either Lantus or Levemir. In cases where the duration is less than 12 hours, some cats (including Pumpkin) have had success with booster shots. In cases where the duration is more than 12 hours (e.g. Langu), caregivers need to learn to predict overlap and carryover effects. People trying to use Lantus as they would a shorter-acting insulin are often frustrated when attempting to adjust dosages based on preshot blood glucose levels. Lantus may well be an excellent choice for diabetic cats once the correct usage methods are established. Use in Dogs Dogs, on the other hand, do not fare as well with Lantus. Using it for them means using the Lantus as a basal insulin with rapid or fast-acting insulins like Novolin R, Novolog or Humalog as bolus insulin, given at mealtimes. This is how insulin-dependent people use it too. Most dogs receive insulin injections twice a day. Using Lantus would at least double the number of needed daily injections because of the need for the faster-acting insulin at each meal. Dr. Rand, of Queensland Protocol fameQueensland Protocol, participated in another studyof Pharmacodynamics & Pharmacokinetics of Glargine (Lantus), Protamine Zinc (PZI), & Pork Lente Insulin Preparations in Dogs-Fleeman & Rand, this time studying the effects of Lantus on dogs. The same 9 healthy dogs were tested with Lantus, beef/pork PZI and porcine (pork) lente insulin. It was concluded that Lantus does not lower blood glucose reliably in dogs; there was no consistent peak time or glucose lowering action, and 2 of the 9 failed to have any significant response at all. PZI was shown to significantly lower bg's with longest duration of action (about 19 hours); pork lente insulin began working faster but had less duration (about 10.5 hours). Usage and Handling Lantus is known to have a noticeable "hospital odor"FDMB Discussion--Lantus--"hospital odor" which sometimes may "ooze" from the patient, too. This is apparently normal. The odor is not from the insulin itself, but from the preservatives in it. In this case, its the metacresol found in Lantus. Metacresol is present in all insulins except those in the Lente family and PZI. A vial of Lantus is only expected to work for 28 days, though some do last longer. It's often best for pet use to buy the smallest vials possible for this reason, which are 3ml insulin pen cartridgesLantus 3ml Cartridges. Unfortunately these cartridges may be hard to come by in your area. More information about keeping Lantus past the Sanofi-Aventis stated 28 day "opened" period comes from the website ChildrenWith DiabetesKeeping Lantus Beyond 28 Days After Opening. The person posing the question uses only a small amount of Lantus daily, having most of the vial left at the end of the 28 day "opened" period. CWD's answer was that pharmaceutical manufacturers use the "worst case" scenarios when making these pronouncements. Keeping the insulin in the fridge gives it a longer opened life than non-refrigerated insulin. CWD went on to suggest the person might be able to keep his/her vial longer than 28 days, by keeping a good eye on blood glucose levels, replacing it when bg levels rise for no explainable reason. Our German feline diabetes friends inform us that people there are having success with storing opened Lantus pen cartridges in the refrigerator(against recommendations), protected from light, between 2 and 8 degrees C (36 to 46 F), but getting good results for up to six months. Of course if "snowflakes" are seen, the cartridge must be discarded. Because of the pH action, Lantus is a bit more sensitive than other insulins -- it needs to have an (acidic) pH of 4 to work, and therefore may not be diluted, mixed with other insulins, or kept overnight in syringes. Lantus and another insulin may be used together in the same patient, but not from the same needle or at the same injection site. (A recent studyUsing the Same Syringe for Lantus and Short-Acting Insulin was conducted regarding mixing Lantus and short-acting insulin in the same syringe. The results show that it did not decrease either insulin's effectiveness. There have been more studies like this regarding the combining of Lantus with short-acting insulins. All have been favorable, but the practice has yet to be approved by any regulating body and/or Aventis.) This from Electronic Medicines Compendium in the UK, is of interest. LantusEMC UK Lantus Information is to be stored at 2-8C, but once in use, pens and cartridges are not to be refrigerated. The information goes on to say that both cartridges and pens must be brought to room temperature 1-2 hours before their first use. Vials have no need for this treatment and are able to be stored refrigerated after opening. Aventis non-vialed delivery systems (cartridges, disposable pens) may have their own set of problems. Each of the Patient Insert Fliers (PIF) at EMC-UK contains a section entitled Problems with the Pen?Lantus Cartridges UK Package Leaflet-Problems With the Insulin Pen?Aventis Insuman Basal Cartridges:Problems With the Pen? The section advises one to always keep some syringes on hand, saying that insulin may be drawn from the cartridges in this manner. A check of EMEA's (EU Drug Regulatory Authority) Lantus information shows Aventis applied for permission to change the rubber stopper for its 3ml cartridges in November, 2004, and for extending the shelf life of unopened product from 2 years to 3 years. A decisionEMEA Documents-Lantus was not rendered until November of 2005. People using Lantus who find that it doesn't last long enough to prevent dawn phenomenon sometimes use a small dose of either Lente or NPH in a separate bedtime injection. This seems to work well for themUsing Lantus & Lente/NPH at Bedtime. Some people do not have 24 hours duration from Lantus, having what's called an "afternoon phenomenon", where the Lantus taken at dinner the previous night appears to be waning before their next scheduled injection. This occurs even though they are using rapid-acting analog insulins for bolus meal coverageInsulin Treatment and Type 1 Diabetes Topics--ADA-Diabetes Care-2006 Studies: Lantus in Cats *Latest Queensland U. article on Lantus in cats *Cases on this site *Tufts U. compares Lantus with Lente insulin *Auburn U. compares Lantus, Lente, and Caninsulin/Vetsulin *Original Queensland U. Article on Lantus in cats *Queensland U. compares Lantus with Lente and PZI *Case study on Bruiser, a cat who achieved remission in 3 weeks on Lantus *Case study Tilly, after 1 year of diabetes, remission after switching to Lantus *Summary posting of FDMB experience of Lantus, by Stef & Toonces *Use of Glargine (Lantus) & Lente Insulin in Cats With Diabetes Mellitus-Journal of Veterinary Internal Medicine 2006 *Understanding Feline Diabetes Mellitus: Pathogenesis and Management-U Queensland-Rand/Marshall-2005 *Criteria for Adjusting the Dose of Glargine in Cats-2005-Rand/Marshall Studies: Lantus in Dogs *ACVIM 2004-Abstract #226- Pharmacodynamic & Pharmacokinetic Comparison of Glargine (Lantus), Protamine Zinc (PZI), Pork Lente Insulin in Dogs--Fleeman & Rand-2004 Medical and Vet information about Lantus *Medical Info sheet *Wendy Brooks, DVM on how Lantus may be good for cats *Initial studies on Glargine including dog trials *Information On Use of Glargine in Diabetic Cats Drs. Rand & Marshall-University of Queensland-June 2006 References Category:Insulins Category:Analogs Category:long-acting Category:Aventis Category:R-DNA/GE/GMCategory:Rx Status